How to help kids cope with social isolation during the COVID-19 pandemic

By Dr. Hannah Greenbaum, neuropsychology postdoctoral fellow at CHOC and Dr. Melanie Fox, pediatric psychologist at CHOC

As we have taken important steps to practice physical distancing throughout the COVID-19 pandemic, virtually all children and teens have had much less interaction with their peers than they typically would.

Peer support is a very important part of childhood and adolescence, as friendships provide support, mitigate feelings of loneliness and boredom, help build a sense of belonging, and encourage identity development. As caregivers, it is important that we promote resilience and help children cope with not being around their peers during this time. For any caregivers who are struggling with how to help children cope with social isolation, there are many things you can do to help:

Encourage creative ways to connect with others:

Help your child come up with creative methods of spending time with their friends. The safest way for your child to talk or play with people outside their household during this time is through video chats or phone calls. One way is to encourage a weekly video chat with a friend or family member. Older children and teens may prefer texting or playing online games with friends. This might require temporarily loosening rules about daily screen time. Children might also enjoy writing letters to their friends. Here’s a few more ideas:

  • Schedule “social time” each day, so your child can look forward to it.
  • Scavenger hunt walk in the neighborhood
  • Create arts and crafts together with friends. Choose a project and supplies in advance and make the same craft as friends over video chat.
  • Video chat with other family members and friends.
  • Set up calls or video chats to allow your child to spend time with extended family and other people important to him or her. You might ask a relative to read a story to your child over the phone or on a video chat. Or, invite family members or friends to a video chat party.

Seek daily purpose:

Kids and teenagers often thrive on daily purpose. Spending time doing activities they care about or value can give your child’s day meaning and help them cope with social isolation. Your child might find meaning through reading, biking, creating music, making movies, baking, dressing up, drawing, writing, planting a garden or building something.

Encourage your child’s unique creativity. To motivate them, consider organizing a family reward board, where for example, by doing something like riding their bike they can earn a sticker working toward movie night.

Older kids might enjoy researching a topic that they’re passionate about and sharing what they’ve learned with friends.

Children and teens often feel rewarded when they help others. Consider encouraging them to find ways to connect with their larger community, like making crafts for the local senior facility, picking up litter around the neighborhood, doing yard work for a neighbor, or finding a safe way to volunteer.

Talk about feelings:

Your child might feel sad about missing an important social event, such as a birthday party. Acknowledge your child’s loss, ask about his or her feelings, and validate them by showing that you understand. Allow your child to lead the discussion, rather than making assumptions about how he or she thinks and feels.

You also might consider giving your child an age-appropriate book that deals with loneliness. This can give your child words to describe his or her feelings. Or, have your child write down what they miss about certain people, places or events as a way to cope. Also, explore different ways he or she might cope with these kinds of losses, such as having a different kind of birthday celebration or planning something for when social distancing is no longer needed. Here’s more tips for talking to kids about disappointment and celebrating special events in a creative way.

Your wise mind vs. your emotion mind

Your wise mind can take in new information, be flexible considering alternatives, and be creative in thinking of solutions. Your emotion mind will urge you to give up, act impulsively or rage. Wait for your wise mind to lead, and make decisions and problem solve with your wise mind.

We cannot control the pandemic, but we can control what we do with it. Your child cannot control the current need for social distancing, but they can control how they choose to deal with the circumstances.

By encouraging your child to connect with others, share his or her feelings, and find daily purpose, you’ll help him or her cope with inevitable challenges associated with this pandemic. Working through this challenge also might contribute to your child’s personal growth and better prepare him or her to deal with future obstacles.

We know children and teenagers will continue to struggle being separated from friends as the pandemic continues. Given the importance of peer support, try to acknowledge the loss your children are experiencing, and work in your wise mind to problem-solve and find ways to continue to find peer support. After all, as the Beatles so eloquently stated, “I get by with a little help from my friends.”

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11 ways parents can help children cope with fires

With brush and wildfires becoming more common in Southern California and many other parts of the world, it’s understandable that children may experience emotional distress, even if their home is not physically affected.

Here are 11 tips from The National Child Traumatic Stress Network and CHOC experts that can help parents and caregivers support kids in coping with fires:

  1. Know these responses are common. Children may feel additional fear and anxiety during a fire – and even long after it is extinguished. Separation anxiety is common, and children may show changes in appetite, school performance and mood. Older children may show an increased likelihood for self-harm and younger children may exhibit regressive behaviors, or showing behaviors they used when they were younger.
  2. Limit media exposure. Monitor children’s media consumption – on television, newspapers, radio and social media. Images of burning buildings or the aftermath of a fire could be frightening to children, as could reading or hearing accounts of the fire. Learn more about the importance of monitoring your child’s news and social media intake.
  3. Monitor adult chatter. Remember that children can overhear conversations between their parents and other adults. They might also misinterpret this information, or be afraid of something they don’t understand. Keep conversations in front of children light and save heavier discussions for private.
  4. Encourage open communication. Children may have questions about the fires – and they may ask them multiple times. Encourage kids of all ages to ask these questions as many times as they need. Use this time to address any misinformation your child might have picked up at school or elsewhere.
  5. Provide age-appropriate information. Limit the information that you provide to your child to the questions that they ask you, to avoid overwhelming them with information that they may not already have been exposed to. Keep in mind their age and emotional maturity when answering.
  6. Remind your children that they are safe. Share your family’s plan to keep safe. Show them where your smoke detectors are located; teach and remind them what to do if those alarms go off. Also, remind children that firefighters and other emergency personnel are working hard to protect them and their homes.
  7. Maintain routines and expectations. Routines are essential to helping children feel safe and secure. Stick to regular schedules, mealtimes and bedtimes as best as possible and ensure children get enough rest, nutrition and exercise. Try to stick to family rules around practicing good behavior, respect and kindness, as well as other family norms, to keep a sense of normalcy.
  8. Increase your patience. Even with routines and rules still in place, practicing flexibility and patience will be key. Distressed or distracted children might need help or additional reminders about chores and responsibilities.
  9. Provide additional support at bedtime. Fears and anxiety could be heightened at bedtime. To avoid your child developing separation anxiety, try to spend more time with them doing light, peaceful activities like reading a book or singing songs. If a child needs to sleep with their caregiver, it’s OK. Just be clear that typical sleeping arrangements will resume in the future.
  10. Model behavior. A parent’s crisis response will significantly influence how children respond. Remember to take care of yourself as well by eating well, sleeping well and exercising. Support your partner or other adults in your life, and, if possible, delay making any hasty decisions during a stressful time.
  11. Read a book. Your child may feel more comfortable opening up about their feelings over the fire by reading a book where the characters experience a fire as well. “Trinka and Sam: The Big Fire” is available for download in English and also available for download in Spanish from The National Child Traumatic Stress Network.

Many of the above reactions are normal after children are exposed to something traumatic like a fire. Parents may wonder at what point their child needs further support from their pediatrician or  mental health provider. Generally if these responses continue more often than not for over two weeks and interfere with normal activities —such as school — or with sleeping or eating, then it may be time to reach out to your child’s doctor or a therapist.

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Talking politics with your kids: Advice for parents

With election season here, it’s hard to miss the onslaught of media coverage and chatter about political issues and candidates. While this is an important time for our country, it can be overwhelming for parents wondering how to talk to kids about politics.

“Politics are front and center right now, making it a great time to talk to kids about the democratic process,” says Dr. Mery Taylor, a CHOC pediatric psychologist. “It’s not something that is abstract – we are all watching it unfold. Now that many kids are back in school, there is sure to be buzz about current events. It’s important for parents to get ahead of the information so they can be prepared.”

Starting a conversation with kids about politics

Dr. Taylor encourages parents to start with the basics. Here are some conversation starters she encourages parents to use:

  • What is a democracy?
  • What are the roles of people in elected office?
  • Why is this happening now?

Next, emphasize your personal responsibility as a citizen to vote, Dr. Taylor says.

“Talk to your kids about what it means to have elected officials that represent the diverse society we live in, and how that helps everybody,” she says. “Discuss the values that are important for your family. It is likely your children know who you will be voting for, but why?”

Parents can use a discussion on politics and the election as a way to model their critical thinking process for their children. To do that, Dr. Taylor encourages parents to talk about the values that shape their decision.

“Explain to your children the process of evaluating candidates’ policies and the impact of those policies on individuals, the environment and the American society as a whole,” Dr. Taylor says. “Children and adolescents are naturally curious creatures and you might be surprised by the questions that they will ask. You may find a conversation with your child or teen might even help you to articulate your own views more clearly.”

Parents can also tailor this conversation to their child’s personal interests, Dr. Taylor says.

“Focus on things that your child cares about. Are they passionate about saving turtles? Help them learn about candidates’ views on animal welfare. Do they want to be a business owner someday? Help them research candidates’ views on small business. Are they interested in health and science? Find out about the candidates’ policies on science and education funding,” Dr. Taylor says. “There are sure to be issues that speak to your child’s interest and help them feel connected to the election, and why politics matter as a whole.”

Share your plan to vote with your child. Take them along to the mailbox or polling station, depending on your voting plan.

How to deal with your child’s stress over the election

If you think your child is probably not affected by the election process, think again – this can be an overwhelming and stressful time for children and teens as well. Dr. Taylor offers the following tips for parents worried about how to talk to kids about politics:

  • Acknowledge your children’s feelings. Ask what they feel and why. Listen closely and try to connect with your child’s emotions before problem solving. If they have concerns or fears about a particular issue or how it may affect your family, reassure them that they are safe and that your family will work out any issue together.
  • Keep the conversation positive. Focus on the positive aspects of a candidate or an issue. Take this opportunity to explain to your kids how to voice their opinions with respect, even when he/she doesn’t agree with someone else. Talk about what you believe and why in a respectful way, too. For younger children, keep the conversation light. For teens, ask them what they’ve heard at school, and/or what they’re unclear about – their answers may surprise you.
  • Talk about the election process. Explain to them that everyone has a voice. While they may not be able to vote, encourage your kids to get involved at school or in the community with issues that are important to them, such as the environment or the economy, for example. Let them know their contributions can make a big difference.
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20+ tips for maintaining and strengthening a family bond during a hospitalization

We understand how important it is to visit loved ones during a hospitalization, especially a child’s. However, for the safety of our patients, families, physicians and staff, CHOC strictly enforces limited visitation on our campus during times such as flu season and the COVID-19 pandemic.

Our pediatric psychologists and child life specialists have teamed up to offer families the following creative ways to stay connected throughout a hospitalization:

  1. Phone calls and video chats are often the easiest ways to stay in touch with a hospitalized loved one. If a patient does not have access to a smart device, the Cherese Mari Laulhere Child Life Department can make special arrangements.
  2. Explore new apps to stay in touch – does the child or teen in your life love using WhatsApp, Messenger, Google Hangouts, Snapchat or other apps? Download their favorite app as an easy way to stay in touch their preferred way.
  3. Send an e-card to a patient at CHOC Hospital.
  4. Use the voice recorder on your smartphone to sing your child’s favorite song, read them a short story, or tell them goodnight or good morning. The parent or guardian who is at the child’s bedside can play the messages on your behalf.
  5. Write to each other in a journal. The child can write a note or draw a picture, and then send the notebook home with the visiting caregiver. Any family members who are at home and unable to visit the hospital can write messages or draw photos in the notebook, and the visiting caregiver can bring it back to the hospital for the child to read.
  6. Assign clinical family liaisons to update non-visiting caregivers or other family members on the patient’s status or call them during rounding.
  7. Family members who cannot be at a patient’s bedside may be comforted by visualizing the space their loved one is in. CHOC has a library of experience videos that can help family members – whether preparing for a visit themselves or not – learn more about CHOC.
  8. Setting up a CaringBridge page can help families share updates and photos with loved ones near and far.
  9. Use Zoom’s whiteboard feature to draw pictures together, write a story or play Pictionary.
  10. Use an online game sharing app to play your favorite board game together online. If a child doesn’t have a laptop available during their hospital stay, their child life specialist can help secure one to borrow.
  11. Pick a craft – anything from painting to decorating a coaster – that all family members can do together via Zoom or video call.
  12. Create a family gratitude journal, where each family member picks three things that they are grateful for every day. Share them with each other via a notebook that is carried from home to the hospital by the visiting caregiver, or with a free journaling app.
  13. Do a scavenger hunt via video chat with different family members. You can each try to find certain items in your spaces that start with a specific letter.
  14. Create coping boxes that kids can use when they feel sad or worried. Some items to consider adding are bubbles, coloring pages, Play-Doh and fidget spinners.
  15. Play a virtual game of Simon Says.
  16. Have family story time through video chat. You can do this at bedtime so family members not at the child’s bedside can participate in their bedtime routine.
  17. Have a virtual, interactive watch party for your favorite TV show or movie using Netflix Party or Disney+’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.
  18. Create and send a personalized Build-A-Bear with a special “get well soon” message.
  19. Create virtual rooms together using Google Slides. Add furniture, people and links to different activities or games. There are many helpful and free tutorials online for creating these rooms.
  20. Create video diaries to keep each other updated on what you’re doing throughout the day – it could be something exciting or mundane. Share with each other via social media or use a free app to string together your video snippets throughout the day. There are also free apps that will allow you to create a calendar showing a photo of something fun or unique you did each day.
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The link between COVID-19 and suicide: What parents should know

By Dr. Meredith Dennis, post-doctoral fellow at CHOC; and Alva Alvarez and Christopher Reeves, mental health social workers

It is an understatement to say that living through the COVID-19 has been tough. For kids and teens already struggling with mental health issues like depression, their symptoms may have worsened with the added stress of COVID-19. No parent wants to imagine that their child would think about ending their life or hurting themselves in any way, but the reality is that kids and teens are not immune to severe symptoms of depression like suicidal thoughts. Unfortunately, we have seen a negative impact of everything that comes with the COVID-19 pandemic on child and teen mental health, including increased suicidal thoughts. This can raise many questions and concerns for parents. Why is this happening? What can I do about it? How can I make sure my child is safe?

A good place to start as a parent is to be aware of the risk factors for suicide. Among others, here are things that could increase risk for thoughts of suicide:

  • Feeling like a burden. If your child believes they are a burden to people in their life, this increases risk for suicide. Keep in mind that it doesn’t matter whether or not this is actually true. It’s about what your child may mistakenly believe.
  • Being disconnected or isolated from others. No matter how much support you try and give, your child may feel lonely or think no one cares about them. This may be especially true if your child feels they do not have any friends.
  • Repeated engagement in self-harm behaviors or suicide The more your child harms themselves or makes attempts at dying, the “better” they get at it. They are also better able to tolerate pain — studies show they experience less pain with more self-harm —, and become less scared of dying.
  • If your child believes that things will stay this way and not get better, there is greater risk. Again, this is not about what is actually happening, but what your child believes to be true.

The COVID contribution

Our lives are nearly unrecognizable these days amid the COVID-19 pandemic. So many elements have changed as we work together to follow various safety guidelines. From the way we go to school and work to the way we interact with our social groups, this new way of life has vastly transformed our routines. Furthermore, these changes occurred suddenly and without warning. It is no wonder that we are seeing increases in symptoms of depression and anxiety, as well as in suicidal and self-harming behaviors. Here are some specific ways COVID-19 may be affecting mental health:

  • Sudden disconnect from peers and support groups outside of the home may increase feelings of isolation while also deterring one’s motivation to seek support, knowing they are unable to interact face to face.
  • Most opportunities we used to enjoy for fun and relaxation have been closed, canceled or restricted. There are limited replacement options. Daily life is now filled with more stress and less fun, making it harder to ignore feelings of loneliness, sadness, worry and hopelessness.
  • Separation from stressful situations within the home may not be possible due to safety precautions. While confined to your home, your child may begin to focus more on their current stressors with little or no distraction from them.
  • A major challenge many families face in these times is financial insecurity or loss of income. Though young, kids and teens are often acutely aware of their parents’ stress. Knowing that parents are worried about finances can increase a youth’s perception of being a burden, and thus increase risk for suicide.
  • Increased exposure to social media and news coverage could lead to increased thoughts and risk of suicide for your teen. Since youth’s activities are severely restricted now, many are spending more time on their screens. This means increased exposure to “doom and gloom” news coverage as well as increased exposure to negative online peer interactions. These things increase hopelessness that the pandemic will ever be resolved and decrease the sense of social connectedness. Increasing suicidal thoughts and behaviors means kids and teens are more frequently exposed to this content online. We know this is a dangerous risk factor for youth suicide.
  • Decreased physical activity along with an increase in screen time may diminish one’s ability to focus throughout the day and negatively affect sleep. Poor sleep and diminished concentration may lead to impaired judgment. This is a recipe for misinterpreting the environment — for example, believing no one cares about them, or feeling like they are a burden.

Accidental adult errors

More often than not, caregivers are doing a great job of reaching out for support and guidance when it comes to a child’s mental health. There are times, however, when adults inadvertently engage in verbal and non-verbal behaviors that can increase or exacerbate risk factors for suicide in children. While these behaviors can be perceived as harmless by adults, to a young person who is already struggling with suicidal thoughts, they can make the difference between ideation and intent. Examples of these behaviors can include:

  • Avoiding conversations about the current state of events, including COVID-19, may accidentally increase distress in youth. This may include avoiding discussing your own thoughts and feelings regarding the impact of COVID-19. Attempting to protect children from the current state of life creates the impression that COVID-19 is too scary to talk about, potentially increasing anxiety or hopelessness about the situation.
  • However, oversharing information — such as financial burdens, parental stress, workload and constant news updates — can also increase suicidal ideation in adolescents by creating what feels like a flood of negative messages that they feel they can’t escape from.
  • Adults sometimes try to help youth feel better by telling them they are overreacting, that things aren’t that bad, or by saying things could be worse. This accidentally increases the intensity of those emotions, leading to escalations of experiences like depression, anxiety and self-harming behaviors.
  • Expecting children and teens to continue functioning at the same pre-COVID-19 levels can place unrealistic pressure on them. Many adults continue to struggle with symptoms of grief related to COVID-19 losses that may be financial, emotional or social.As a result, adults have had to make adjustments to their own expectations for “normal” functioning. Youth also need to know that they are allowed to make adjustments and that not everything needs to be perfect.

Action steps to support children and teens suffering during COVID-19

There are things you can do as a parent, guardian or caregiver to help children and teens who are suffering during this time. Kids are resilient, meaning they have the ability to “bounce back” when difficult things happen. There are also several protective factors to be aware of that are helpful in lowering the chance your child will experience more serious risk. Here are a few ways you can help:

  • Stay connected. With social distancing guidelines in place, it may be difficult to find safe and appropriate ways to keep your child socially engaged that meet your needs. Set up virtual hang-outs with friends, or meet at an outdoor space like a park where social distancing can be maintained if everyone agrees to wear a face covering.
  • Stick to a routine. Maintaining predictability in the day can help your child build structure and have a sense of security. Daily routines also help increase engagement in activities, which can increase feelings of accomplishment and self-confidence, directly reducing things like hopelessness and feeling like a burden.
  • Have a conversation. Setting aside time to talk to your child about how they are feeling is important. Give them a safe space to share their thoughts and feelings. Show them you are there to help by validating them and being supportive. Let them know it’s OK to feel the way they feel and that you will get through it together.
  • Find time for self-care. Keep your child engaged in things they like that are fun and/or relaxing. It works best if you do this with them! Do fun things or a favorite activity, do things you are good at, learn a new skill, and keep them involved in extracurricular activities like sports or clubs if possible.
  • Take care of basic physical needs. A healthy body helps us be as prepared for the daily stresses as possible. Get enough sleep, move your body and eat balanced foods.
  • Limit screen time. Even though our lives revolve almost exclusively around screens, make time to disconnect and seek social connection, fun, relaxation and joy using “old school” ways.
  • Self soothe. We could all use some extra comforting these days. Teach your children to use their physical senses to comfort themselves by listening to relaxing music, finding a soft comfort object such as a blanket or T-shirt, or using a favorite scented candle or lotion.
  • Seek mental health support when needed. If your child seems to be having a pretty hard time and does not already have mental health services like therapy or counseling in place, this would be a great time to start. Medication may also be an option. Talk to your doctor, insurance, or school about where to get connected.
  • Get immediate help if needed. If your child continues to express thoughts about harming themselves or dying, go to the nearest emergency room or call 911.
  • Help your child identify reasons to live. What is important to your child? What are their values and goals? Helping them get connected to these things can be a very powerful way to recognize that they have things in their lives that are important and matter – and that this situation is not going to last forever.
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